Decision‑making in hospital‑wide patient flow: a multiple‑case study of leading academic hospitals

Journal article, 2026

eHospitals face increasing pressure to manage rising patient demand with limited resources, making efficient patient flow a critical operational challenge. While prior research has examined patient flow from various perspectives, little is known about its practical operationalization and how decision-making within production planning and control supports responsiveness. This study examines how hospitals allocate decision-making authority to manage patient flow by analysing what decisions are made, where, and by whom in daily operations. An international multiple-case study of five academic hospitals, based on site visits and interviews, shows that hospital operations require planning and control approaches distinct from manufacturing. Rather than strict hierarchical control, hospitals engage in continuous resource rebalancing and patient reprioritization across interdependent units. Decision-making is largely decentralized to enhance frontline responsiveness and patient safety, complemented by centralized coordination through command centres. We propose a framework extending traditional production planning and control by integrating local rebalancing with central reprioritization.